MOOD DISORDERS IN YOUTH 1

Mood Disorders in Youth: Issues and Treatments

Caroline Cates

University of South Carolina

Abnormal Psychology– Section H01

October 21, 2015

MOOD DISORDERS IN YOUTH 2

Mood Disorders in Youth: Issues and Treatments

One out of every five high school students has reported seriously considering suicide, and

it is the third leading cause of death for the age group (Coyle, 2009). Additionally, up to two

percent of prepubescent children meet the criteria for major depressive disorder (Coyle, 2009).

Even though depression significantly affects the lives of these young people, the treatment

options and support systems are far from adequate. Mood disorders present themselves

differently in youth versus adults, yet the youth are still treated based on the research and

methods shown to be effective for adults. New research is currently underway to fix this system

by finding more appropriate ways to reduce the symptoms in youth and give them a greater

opportunity for living with a lighter burden for the future.

Children are at risk for early onset mood disorders based on a variety of factors including

family history and genetic predisposition as well as environmental factors. Early onset of bipolar

disorder is strongly linked to family history, yet there still remains no identifiable gene to predict

mood disorders. However, several chromosomal locations are currently under scrutiny. One

likely scenario is that several genes are in play, and the identification of these genes would allow

better predictability for a person’s chances of depressive symptoms (Coyle, 2009). Nevertheless,

extensive research in pathophysiology is still necessary to be able to predict a child’s genetic

risk. Interestingly, while women are more susceptible to depression in adulthood, girls seem to

have a higher risk only following hormonal changes during puberty. Prevalence of mood

disorders is equal between boys and girls before puberty, but the number doubles in girls

following (Coyle, 2009). Situational problems can also affect a child’s mental health, especially

if they have a predisposition for depression because of a family history. Stress from lack of

security or support from family can augment symptoms of depression or likelihood that a child
MOOD DISORDERS IN YOUTH 3

will develop an early onset disorder (Coyle, 2009). All of these factors contribute to whether a

adolescent will experience depressive symptoms, yet only severe symptoms will catch the eye of

anyone prepared to help. Their symptoms may also be compounded by a comorbid problem,

which may overshadow their depression or confuse the subjective diagnosis.

Children have high comorbidity rates with other mental issues, such as anxiety disorders

or symptoms, which can predict issues with mood disorders in the future (Foltz, 2006). Studies

suggest that anywhere from forty percent to seventy percent of youth diagnosed with major

depressive disorder also show symptoms of another disorder, with one in five meeting the

criteria for more disorders (Fonagy et al., 2002). Conduct disorder shows a strong connection

with major depressive disorder, and ADHD shows a possible connection to early onset bipolar

disorder with a weak link to early onset major depressive disorder (Chanen, 2015). Children may

also experience depression as a comorbid condition to another mental illness such as ADHD or

anxiety, even though they don’t necessarily meet the criteria for major depressive disorder or

bipolar disorder. In addition, symptoms of early onset bipolar disorder vary and can be easily

mistaken for other conditions like distractibility with ADHD. The same applies to the symptom

of irritability, which can fit several different disorders (Chanen, 2015). This can cause confusion

when a psychiatrist is diagnosing a client. According to Robert Foltz, PsyD, “Because of the

dramatic comorbidity and/or symptom overlap of bipolar disorder with [other] disorders, a study

examining a treatment with ‘bipolar disorder’ may, in fact, have little applicability because a

high rate of bipolar disordered youth do not simply fall into that diagnostic category. As a result,

applying treatment methods specific to bipolar disorder becomes less ‘evidence-based’”(Foltz,

2006). In other words, youth do not adhere well to the paradigms put in place for adults, making

the diagnosis more subjective and therefore more prone to a misdiagnosis based on symptoms
MOOD DISORDERS IN YOUTH 4

from different comorbid disorders.

Adolescents who show depressive symptoms, but are not diagnosed with major

depressive disorder, have a high risk of being diagnosed with a mood disorder later in life

(Coyle, 2009). With this predisposition in mind, early intervention could create greater social

change in the future by reducing the impact of the disorder on the individual. This change would

help on a societal level by allowing these people to become more stable and functional members

of society. Early intervention could include increased counseling personnel in schools, teacher

programs that instruct educators on what warning signs of mental distress to look for in their

students, and early education about mental illness with a non-stigma approach.

The common stigma surrounding depression limits the effectiveness of help that youth

can receive. Parents and youth may believe that symptoms are easily overcome by mental

prowess, thus limiting the help the child receives until the groups involved can understand that

the child has a treatable illness. That which is often dismissed as moodiness can be an indicator

for serious impending problems. Statistically, parents who show more understanding towards

mood disorders are white, female, have older children, and/or have a higher level of education

(Pine et. al., 1999). In other words, some children will start out with a better support system than

others when it comes to their mental health. Some parents may be supportive in many ways

academically and socially, but they may not be able to adequately support their child through a

mental illness due to their lack of understanding. This information demonstrates a need for

public mental health initiatives that can educate parents. Anti-stigma initiatives in schools would

also benefit the youth themselves, whose darkened self-perception is further harmed by the

assumption that their inability to cope with their emotions is a character flaw and not a treatable

illness. If all children in schools today were taught about mental illness in an honest way early
MOOD DISORDERS IN YOUTH 5

on, the stigma could be significantly decreased over the next few decades. A further connection

to stigma was observed in a 1999 study, which tested the theory that persistent “moodiness” in

adolescence may be a precursor for mood disorders later in life. They were correct (Pine et. al.,

1999). Since a low mood is common among teenagers, youth with persistent subclinical

depressive symptoms are easily overlooked because of the societal assumption that their low

mood is normal. However, early counseling intervention may be beneficial to those adolescents

before their symptoms worsen. Some youth, however, do show severe symptoms of mood

disorders that need attention.

According to NIMH Blueprint Report, “more than 70% of children and adolescents with

serious mood disorders are either undiagnosed or inadequately treated” (NIMH, 2001). Training

for assistance for mood disorders in youth is limited to child mental health specialists. This is a

problem because general psychiatrists and physicians without this special training for youth will

treat the child with treatments that are known to be effective for adults, but they are not

necessarily effective for adolescents. Children are less able to express their internal mood states

and changes because they must understand what is being asked and be able to have a perspective

of their overall mood over the span of several weeks, a difficult feat for some children. In his

article, The Mistreatment of Mood Disorders in Youth, Robert Foltz argues that by assuming

depression presents itself in youth in the same way as adults, the assumption is also made that

depression feels the same to both youth and adults, which is inherently an improbable guess.

Since symptoms are linked to mood and social pressures, the difference in life experience, self-

image, and mental development will obviously play a role in how the person feels and interprets

his or her depression. It is known that, physically and chemically, the brain of an adult is

different from that of a child. Because of this difference, the two may likely experience emotion,
MOOD DISORDERS IN YOUTH 6

and thus depression, differently. Even basic cognitive-behavioral therapy will not appear the

same for youth and adults because of the physiological development of the brain and cognitive

processes (Foltz, 2006). Consequently, interventions for adults and youth should look different

as well, including both counseling methods and pharmacology.

The most common group of antidepressants, Selective Serotonin Reuptake Inhibitors

(SSRIs), indicates startling health concerns for youth. The popular drugs often increase suicidal

ideation in adolescents, prompting the Federal Drug Association to take action and issue

warnings about thoughts of suicide, and occasionally suggesting a minimum age requirement of

eighteen (Foltz, 2006). Furthermore, while the rate of people using SSRIs has increased over the

last two decades, a study by the FDA in 2004 revealed that the drugs were relatively ineffective

in youth. Of the studies comparing SSRIs to a placebo for adolescents, eighty percent showed no

benefit to the SSRI over the placebo (Laughren, 2004). On the other hand, a trial funded by

NIMH found that the most effective form of treatment involves both medicine and counseling

(NIMH, 2001). Nevertheless, the evidence against the use of SSRIs in youth demonstrate that

this method is not as effective in adolescents as adults and an alternative option would be more

beneficial to the age group.

While talk therapy and counseling are generally considered the best method for any age

group, additional treatments are useful as supplements and for people with strong hormonal or

neurotransmitter imbalances (Foltz, 2006). The evidence that traditional adult treatments are not

as effective for youth has prompted new research for several alternative theories and ideas. Trials

are underway for complementary and alternative medicine (CAM) antidepressant treatments,

which may be promising for adolescents. Currently, the results present weaker evidence for

youth than adults. However, the few controlled trials have presented promising data that needs to
MOOD DISORDERS IN YOUTH 7

be researched further (Popper, 2013). If efficacious, CAM treatments would be received well by

the public because they are inexpensive, carry little stigma, and tend to have very few side

effects, One exception is Hypericum, a CAM treatment that is under extensive study. While the

drug shows similar effects and drug interactions to pharmaceutical antidepressants, the adverse

effects are less predictable. Two other promising treatments, S –adenosylmethionine and 5-

hydroxytryptophan, have still not been researched thoroughly for youth despite being effective

for adults (Popper, 2013). Some professionals believe that medicating children, which sometimes

causes uncertainty with long-term adverse effects, is not the best option for therapy. Therefore,

in recent years, research has been conducted on other options as well that do not involve

medication.

Researchers are pursuing more natural therapies for youth, such as regulated regimens for

physical exercise, which has decreased amongst youth in the last decade (Popper, 2013). For

adults, research has shown that exercise releases neurotransmitters associated with depression

(Coyle, 2009). Studies involving exercise with youth showed moderate improvement in mood for

major depressive disorder and nonclinical depressive symptoms. The type of exercise, such as

aerobic activities or strength training, has shown little difference in these studies (Popper, 2013).

Another idea based on natural stimuli is light therapy, which uses the brain’s natural reactions to

light and darkness as stimulation to help treat major depressive disorder, seasonal affective

disorder (SAD), as well as delayed sleep-phase disorder, which shares symptoms with depression

(Popper, 2013). Light therapy on its own has not presented success, despite the connection of

seasonal affective disorder to the time of year and the amount of light during the day because of

the season and the physical location (Coyle, 2009). While these ideas are promising, it will be

years before any are ready to treat youth, and few seem to work without additional long-term
MOOD DISORDERS IN YOUTH 8

counseling (Popper, 2013). Research is still needed in this area of study to continue to improve

the treatments for this age group.

Mood disorders are often ignored by society because the traditional view of depression

has negative connotations of weakness that people do not want to associate with themselves. The

public often sees mental disorders as purely conceptual and not a real physical illness. This

stigma, though slowly decreasing with more research and education, has limited the treatment for

young people with mood disorders because they do not know how to share their discomfort or

when to recognize when they need help. Adolescents with depression problems are also put at a

disservice by current psychiatric practices, which treat youth as adults even though

physiologically they respond differently. In other words, in order for children and teens with

depression to get proper mental health attention, several problems need to be resolved. Stigma

needs to be reduced, public education of mental illness needs to be increased, and most

importantly, extensive research needs to be done to find new, effective methods for relieving the

distress of this neglected age group. These problems cannot be solved by one individual, but

rather by a collection of people working toward the same goal of aiding the tomorrow’s youth.
MOOD DISORDERS IN YOUTH 9

References

Chanen, A. M., & Thompson, K. (2015). Borderline personality and mood disorders: Risk

factors, precursors, and early signs in childhood and youth. In L. W. Choi-Kain, J. G.

Gunderson, L. W. Choi-Kain, J. G. Gunderson (Eds.) , Borderline personality and mood

disorders: Comorbidity and controversy (pp. 155-173). New York, NY, US: Springer

Science + Business Media. doi:10.1007/978-1-4939-1314-5_9.

Coyle, M.D., J. et. al. (2003). Depression and Bipolar Support Alliance Consensus Statement

on the Unmet Needs in Diagnosis and Treatment of Mood Disorders in Children and

Adolescents. Journal of the American Academy of Child & Adolescent Psychiatry,

42(12), 1494-1503. Retrieved from ScienceDirect.

Foltz, R. (2006). The Mistreatment of Mood Disorders in Youth. Ethical Human Psychology

and Psychiatry Ethic Hum Psychology and Psychiatry, 8(2), 147-155.

Fonagy, P., Target, M., Cottrell, D., Phillips, j . , & Kurtz, Z. (2002). What wcyrks for whom? A

critical review of treatments for children and adolescents. New York: Guilford Press.

Laughren, T. (2004). Background comments for February 2, 2004, meeting of

Psychopharmacological Drugs Advisory Committee (PDAC) and Pediatric

Subcommittee of the Anti-Infective Drugs Advisory Committee (Peds AC).

Pine, D., Cohen, E., Cohen, P., & Brook, J. (1999). Adolescent Depressive Symptoms as

Predictors of Adult Depression: Moodiness or Mood Disorder? American Journal of

Psychiatry AJP, 156(1), 133-135.

Popper, MD, C. (2013). Mood disorders in youth: Exercise, light therapy, and pharmacologic

complementary and integrative approaches. Child and Adolescent Psychiatric Clinics

of North America, 22(3), 403-441.

MOOD DISORDERS IN YOUTH 10

The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DlSC-2.3): Description,

acceptability, prevalence rates, and performance in the MECA Study. Methods for the

Epidemiology of Child and Adolescent Mental Disorders Study. Journal of the American

Academy of Child and Adolescent Psychiatry, 35, 865-877.